Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME61377 | FL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | ME0061377 | FL |
NPI | 1124022546 |
---|---|
Provider Name | Oscar Perez |
First Address | Tampa, FL 33618-2059 |
Second Address | Tampa, FL 33618-2059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265467900 | (05) | FL |
F14773 | (02) | FL |